Facial Nerve Disorders

Overview

Facial paralysis, often referred to as Bell's palsy, is a weakness or paralysis of the nerve that control facial expression on one side of the face. The disorder results from an insult to the nerve that stimulates the movement of the facial muscles. This in turn results in the weakness or complete paralysis of the face on one side.

Facial paralysis is most often caused by a virus infection of the facial nerve. However, other conditions such as tumors, other infections, trauma, among others. The condition is more frequent in diabetics and pregnant women.

Bell's palsy caused by a virus infection most commonly resolves on its own in several weeks or months. When patients present within a week after diagnosis, corticosteroid (prednisone) and anti-viral medication for 1-2 weeks, to increase the likelihood of recovery.

Presenting Symptoms

Facial palsy presents with weakness on one side of the face. About half of patients with Bell's palsy present with pain behind their ear or on their face, which may precede the paralysis by a few days. Tearing on the side of the paralysis is common and so is an altered taste on the same side of the tongue. Some patients may experience intolerance to loud noises on the same side as the paralysis.

Causes

Facial paralysis can have multiple causes. The most common cause is a virus infection within the facial nerve. Other causes include infections of the ear, strokes, fracture of the temporal bone (the bone that encases the ear area), inflammatory conditions such as sarcoidosis, and tumors of the facial nerve, skin, temporal bone, or parotid gland (saliva gland).

How is a Diagnosis Made?

Generally after a complete history and physical exam, some tests need to be performed to diagnose the cause of facial paralysis. A hearing test (audiogram) and usually a test of the facial nerve (electroneurography, ENoG) is performed. Imaging of the temporal bone, brain, and the face may be warranted to evaluate the entire course of the facial nerve.

Treatment

Treatment of the facial paralysis depends on the cause of the facial paralysis. In cases of infections, antibiotics are prescribed and surgery may be necessary. In other cases, steroid medication (prednisone) is prescribed in combination with an anti-viral medication. In cases of tumor or paralysis resulting from resection of tumors of head and neck, the treatment usually consists of one or more of various facial reanimation procedures.

A critical element of the treatment of facial paralysis is the care of the eye. Although there is generally tearing on the side of the paralysis, the surface of the eye gets dry from the inability to close the eye entirely. Therefore, initially a combination of artificial tears and a lubricating ointment is used to keep the eye moist and the eye is taped closed when sleeping. For persistent or long-term paralysis, canthoplasty and/or gold weight placement to the upper eyelid should be considered.

Botox (Botulinum Toxin A) is used commonly by Dr. Djalilian for patients with too much activity in the face after recovery from facial paralysis. Botox is sometimes used to slightly weaken the normal side to match the weakened side as well.

Recovery

The recovery from facial paralysis is generally dependent on the cause of the paralysis. While recovery from facial paralysis caused by tumors is unlikely, Bell's palsy or idiopathic facial paralysis patients have an 85% chance of complete recovery. The chance of recovery is less in patients who have diabetes.

Other Facial Nerve Disorders

Facial Spasms

Facial spasms, or hemifacial spasm are disorders characterized by intermittent spasms of facial muscles, the whole side of the face, or the eye. This condition can be caused by sensitivity of the nerve or pressure from a blood vessel on the brain. This condition is treated using BOTOX injections or by doing a surgery to take off the blood vessel that is pressuring the nerve. This surgery is generally performed in conjunction with a neurosurgeon.

Ramsay Hunt Syndrome (also called Herpes Zoster Oticus)

This condition occurs when the shingles virus affects the facial nerve. Patients will often have pain in the ear and some blisters around the ear or in the ear canal. This disorder is treated in the same way as Bell's palsy. The likelihood of recovery to normal function in this disorder is 50-60% compared to Bell's palsy which generally recovers to normal function in 80-90% of individuals.

Facial Neuroma

Facial neuroma (also called facial schwannoma) is a tumor of the facial nerve. This tumor is slow growing and over time can cause facial paralysis. The treatment of this tumor is by removal of the tumor using surgery. The nerve is often replaced with another nerve from the leg or the neck. The recovery of the function is never complete, but tone can be restored with some movement. Sometimes if the tumor is discovered and it is not causing facial paralysis, the tumor may be observed over time and removed only after it causes facial paralysis.

Trauma

Trauma to the nerve, either from cutting the nerve or fracture of the bone surrounding the ear (tempral bone), can cause paralysis of the face. The treatment depends on the time of the injury, the location, and the onset and extent of the paralysis. UCI's facial nerve specialist, Dr. Djalilian, can give you more information on the options given the complexity of the possibilities.

Facial Nerve Tests

Depending on the disorder and the time of onset, several tests of facial nerve function or imaging tests, such as CT or MRI scans may be obtained. The facial nerve tests include the electroneuronography (ENoG test). This test allows the specialist identify the extent of the injury to the nerve or onset of paralysis in the first 21 days after the injury. The facial nerve electromyography (EMG) test is meant to identify the prognosis and progress of recovery after 21 days from the injury or onset of paralysis.

Multidisciplinary Care

The diagnosis and treatment of facial paralysis is generally carried out by your physician in addition to a consultation with an otolaryngologist (ear, nose, and throat / head and neck specialist). The facial paralysis center at UC Irvine is based in the Department of Otolaryngology-Head & Neck Surgery and under the direction of sub-specialists in the treatment of facial nerve disorders. These are Dr. Djalilian (neurotologist), Dr. Lin (neurotologist), Dr. Goddard (Head and Neck/Microvascular Reconstructive Surgery), Drs. Crumley and Wong (Facial Plastic and Reconstructive Surgery). The team also includes an audiologist (hearing/balance/facial nerve testing specialist), neurologist (brain specialist), ophthalmologist (eye specialist), and physical therapist.

Why Come to the UC Irvine Facial Paralysis Center?

The UC Irvine Facial Paralysis Center focuses on the diagnosis and treatment of patients with acute or chronic facial paralysis, multi-disciplinary rehabilitation for patients, and research into the cause and care of patients with these conditions. The latest techniques of diagnosis and treatment of acute and chronic facial paralysis are used. The team presents their latest research and clinical work at national and international meetings.

To Make an Appointment with at the Facial Paralysis Center, Please Call 714-456-7017 or click here to request an appointment via the web.

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